Abstract Number: Esoc2026a1819 Prehospital Triage, Hospital Selection and the Decision to Withhold Recanalization Therapy in Acute Ischaemic Stroke

Abstract Background and aims Most ischaemic stroke (IS) patients do not receive recanalization treatment. We analysed IS patients identified via Emergency Medical Services (EMS) to assess factors – including those related to prehospital transport decisions – contributing to final treatment decisions. Methods We retrospectively reviewed all EMS-identified IS patients aged ≥16 years in Uusimaa region (population 1.7 million) over a 4-month period, regardless of transport priority or receiving hospital. EMS and hospital records were analysed to identify reasons for transport triage, hospital selection, and decisions to withhold recanalization therapy. We also examined patients who received treatment despite not being transported with high priority to the comprehensive stroke centre (as recanalization candidate) and assessed potential missed treatment opportunities related to triage or hospital choice. Results Among 415 patients with a final diagnosis of IS treated in eight hospitals, 318 (76.6%) did not receive recanalization therapy. The main reasons were delayed presentation, mild symptoms, or contraindications to treatment. These factors affected both EMS transport and in-hospital decisions. Of 195 patients transported as recanalization candidates, 91 (46.7%) received recanalization treatment. Six patients (2.7%) received treatment despite not being transported with high-priority stroke code. No missed treatment opportunities were attributable to EMS transport decisions. Conclusions The main barriers to recanalization therapy stemmed from patient-related rather than EMS-related factors. EMS transport decisions were largely accurate. All ultimately non-treated patients had clinically justified reasons for exclusion, typically identifiable prehospitally. This highlights the importance of precise EMS assessment for an effective stroke pathway and optimized recanalization therapy rates. Conflict of interest Kristina Wikman: Nothing to disclose, Silja Räty: Nothing to disclose, Markku Kuisma: Nothing to disclose, Tuukka Puolakka: Nothing to disclose, Daniel Strbian: Nothing to disclose. Figure 1 - belongs to Results Figure 2 - belongs to Results Figure 3 - belongs to Results